October 1, 2012

So this morning begins the second week of my very low carb diet experiment. Here's what LifeForm has to say about what I ate.

Sodium: 1568 mg
Vitamin A: 112%
Vitamin C: 95%
Calcium 83%
Iron 27%

Since I only ate one meal away from home, I was able to weigh all my portions and use label information.

The low iron is fine. Too much iron is a problem for many of us with diabetes and many older people. Since I dumped my cast iron cooking pan, when tested mine is always normal. If it dropped, the cast iron pan would quickly solve that problem.

My weight this morning was 142.4. lbs

My average fasting weight for the past week was 144.0

This average doesn't include my morning weight the day that I started the diet.

This represents a loss of 2.3 lbs since the morning after my first full day of dieting. (I did not use my starting weight as it was artificially high thanks to having eaten a very salty meal the previous day.)

Boring Food Does Make It Easier to Diet

As I mentioned in an earlier post, I have been home-testing Stephan Guyenet's palatability thesis. So far it looks like he may have a point. One huge benefit of eating almost the same food every day and doing no cooking fancier than frying up an egg or baking a chicken is that it cuts way down on thinking about food.

A few days ago I stopped in to visit one of the active low carb forums (one that banned me a few years ago, most likely for telling the truth about the bogus "low carb" crap the site owner sells.) The main thing that struck me was how obsessed with food all the posts were. Everyone was posting recipes, many of them extremely high in calories, and often they were for cakes, desserts, and candy-like treats. Just reading the site made me start craving food.

Bad!

The rest of the time when I knew exactly what I was going to be eating I did not think about food until it was time to eat my [tiny] meal. No way was I going to be slavering thinking about eggs with cheese for breakfast, salad with meat and cheese for lunch, yogurt with sunflower seeds for dinner.

Thinking about food may in fact get the brain secreting hormones that change our metabolism in ways that fight weight loss.

Take Away Lesson: Though variety is essential for maintaining a low carb lifestyle, and also likely to be very important for sustaining a successful diet phase, it might be a very good strategy to eat one set group of foods each week and only research (and shop) for the next week's foods during a short period of time. Look at the recipe sites and cookbooks before you start your weight loss diet--or while you are maintaining.

More Thoughts on Glycogen
When I started this experiment I was taking 1000 mg of metformin every day. I had to stop taking it mid-week because my blood sugars were so low that I didn't need even the small lowering that metformin produces.

After the first day's loss--which was likely mostly salt from that Vietnamese lunch, I didn't lose anything for about 4 days, then I dropped another couple pounds. I have often observed that metformin blocks the early loss of glycogen that occurs when I eat a ketogenic diet. My guess is that stopping the metformin allowed me to lose more glycogen.

I'm starting to think that metformin somehow "locks" the liver glycogen which is why it can be so helpful in lowering fasting glucose. But it also means you can't lose glycogen when you are in a ketogenic state. Since that stored glycogen isn't accessible when you take metformin, this isn't an issue, but it can make for odd patterns of weight loss.

In any event, as gratifying as the number on the scale my be most of the weight loss is glycogen and will come back when I eat more than 70 grams of glucose (my own personal ketogenic threshhold. Many people's are higher because they are larger than me.) I maintain around 100 g a day, so I won't really know how much fat I lost for a while.

I was turning ketone strips pink all the time, mostly "small", with one "moderate" and one "light" reading. Interestingly the "light" reading occurred when I was feeling really hungry and before a drop in scale weight. Perhaps that is a sign I was burning newly freed-up glycogen as the metformin wore off.

Hunger
I had long periods when I wasn't hungry, but noticed that I did get hungry--often very hungry--in the evening 4 or 5 hours after my last meal. (No snacks on this diet!) I resorted to the "Two Gram Cure" and it worked. When I tested my blood sugar at these hungry time it was usually in the 70s.

This confirms my belief that for me, at least, it is blood sugar level that causes hunger.

Wheatlessness
Since my blood sugar normalized on the Coenzyme Q10 I have been eating quite a lot of wheat. I went completely grain free this week, but so far I can't say that I noticed any of the magical changes claimed for going wheat or gluten free.

I don't have any of the kinds of antibodies associated with gluten allergy nor do I have any history or family history of autoimmune disease, so this is predictable. I still had some heart burn, mostly because yogurt causes me to have heart burn.

Blood Pressure

It's up, sadly. This often happens when I eat a very low carb diet, contrary to the "one-size-fits-all" claims of those who make millions selling diet hope. After one day when it dropped, it went right back up and was alarmingly high another morning, though responsive to medication (captopril). Some of this may have to do with it getting cold here on our windy hilltop and my refusing to turn on the heat (expensive oil) while the calendar read "September." Cold will raise blood pressure, but probably not as much as mine is rising.

Blood Sugar
Fasting this morning was 83 mg/dl, again suggesting that the metformin is wearing off. Post meals it is dropping into the 70s. For the last thee mornings my fastings were in the 70s.

Energy Level
Not great, in fact, I've been really droopy much of the time. I have had some trouble sleeping and I have been having those very vibrant dreams that often come with ketosis.

Plans for This Week

I'm going to stay in ketosis this week but raise my calories to 1250 as I don't think starvation diets are smart. The extra calories will be fat. Not having me eat with him is a stress for my Sweetie, who, as men are prone to do, has lost more weight simply because he is having to get his own meals and we aren't doing any social eating, than I am eating like an anorectic bird.

I'm remembering the social toll that is taken by not making meals a major part of socializing. I will be glad to get back to my usual regimen, hopefully having eliminated the carb creep that happened over this past summer. I'd like to stay maintaining at my usual 100-110 g a day level and 1600 calories a day (which is a tad higher than what the calculator says I should eat, but is what I can eat without feeling like I'm starving myself.)

I wish you would monitor not your weight but your body fat percentage. Loosing weight is at best meaningless because we don't know whether your loosing water, muscle mass or body fat. No one, but especially women, should loose muscle mass on any diet - it's too hard to replace. But you have no idea how much protein to eat without knowing your lean body mass and so no idea how much to eat to preserve the muscle mass you have.

Measuring body fat is not as exact as measuring weight, but a pair of calipers and this calculator will give you reasonable way to track body composition. See: http://www.free-online-calculator-use.com/skin-fold-test.html

If Volek & Phinney suggest eating that little protein during the first weeks of a low carb diet they are badly misinformed because the brain needs extra glucose during the switchover period. If it doesn't get it from diet, it will get it from breaking down muscle tissue, including the heart.

Their recommendation is suitable for later on when the calculator I use would prescribe 64 g a day of protein.

I discussed this at length in the previous blog post. The level I ate at was lower than the level suitable to the total newbie, but accounted for some time spent in the transition.

Kim,

I monitor my body fat percentage daily with a Tanita scale but the daily fluctuations are such that a weight loss of this size with the accompanying changes in water balance due to glycogen loss make the readings right now uninformative.

I'll post them when the experiment is over and I'm back to my usual amount of water onboard.

Considering that I'm just looking to knock off 2 or 3 lbs, I doubt calipers would be any more informative.

After a significant weight loss they might be, but a low carb diet with sufficient protein should spare LBM. I would save the money invested in calipers and put it into a much more useful food scale or if you have one, high quality additive free meats and cheeses.

Jenny, your Energy Level comments coincide exactly with my experience low-carbing with my husband a couple of months ago. He on the other hand had more energy and felt good in the induction phase. Your comments about metformin use while low-carbing are also very useful. Thanks for continuing with the detail on your ketogenic diet.

Hi Jenny, thank you so much for taking us along on your journey, VERY helpful info. Curious about your CoQ10 supplement, do you have a preference on brand/dosage? I am trying to repair some damage caused by statin use.

On the contrary: You're currently 144lbs. Let's assume you're in the "acceptable" range with 25% body fat. You want to loose 3 lbs of body fat. Do the algebra and you'll see that your body fat is now a "fit range" 23%. That most certainly is measurable and important to track. By measuring body fat you can tell if you're losing muscle mass and take appropriate steps.

Tracking only weight has serious implication. For example: I was in the hospital a couple of years ago with a serious infection. The hospital managed my diabetes with insulin rather than diet. I emerged from the hospital weighing 5 lbs less from whenn went in. But when I took my body fat I found that I had lost 10 lbs of muscle and gained 5 lbs of body fat! A disaster for my long term health.

You simply can not know what you're doing if you're only measuring weight loss rather than body composition.

You can not know how much protein to eat without knowing your lean body mass.

In terms of your energy level: that will improve the further into ketosis you go. I'm an endurance athlete and was worried about well "my endurance" being on a ketogenic diet. In fact, it's much better. Explained in the following book but my own personal experience is that I never "bonk." It's great to finally regain the energy level I had 30 years ago.

I started out taking 50 mg of CVS brand (the cheapest available, and often 2 for the price of one.) After a few days I started taking it only every other day, and then as time went on I skipped more time between doses.

When I take too much it drops my blood sugar too much, so I adjusted the dose based on blood sugar.

My diabetes is of an unusual kind, so I don't know what impact this kind of dose would have on someone with a different form.

Most people take a lot more, but it is possible that too much is less effective than just the right amount due to the way antioxidants work in the mitochondria.

Your experiences are very relevant to your own body. But there is no one-size-fits-all prescription for health, contrary to what doctors who earn million dollar advances for their books will tell you. They sell books by oversimplying things and making it sound like they have found some magical secret.

Eventually people find their magical secret doesn't work, and move on to the next million dollar bestselling fad book--while the authors of the old one rewrite their book with a new title that copies whatever the current bestseller might be and steal ideas from it.

It's a nasty business, which is why I avoided writing about diet for so long and why, when I did, I confined myself to theories that could be backed up with solid research.

I've examined Volek's publications, but they are very limited in scope and very short in duration which makes them less compelling than some other larger, longer studies. Plus, the advances he gets make it impossible for him to be objective. He has to pursue the course he does to get the advances and the publisher push.

I was in full ketosis for over 5 years and felt like crap for the last 3 years of it, even with an aggressive exercise plan and a very fit LBM measured with calipers, so no, it doesn't necessarily get better.

People are different. My mom's friends and sister who were religious about going to the gym and watching their weight died a decade younger than she did.

The whole message my books communicate (and they are not backed up by advances from anyone so I can tell the truth) is that people are different and each of us has to find the solution that works for our own unique situation and metabolism.

I'm glad you found something that works for you, but carrying extra body fat does not guarantee health. In fact, most studies of the subject find that overweight older women survive much better than others, even when the ones who were already sick are removed from the research pool.

Coincidentally, there's an article about this in the NYTimes that a friend just sent me: HERE

I'm in my mid-60s and at a normal weight for my size. I'm carrying a bit more fat than the "ideal" prescribed for people in their 20s. That's fine with me.

Heh! I know about boring. I'm doing GAPS, and am just finishing up stage 2.

Stage 1 is boiled meat, boiled veggies and bone broth - which translates to soup, soup and soup. I'm trying to avoid ketosis, so a LOT of carrots, onions, peas and squash are involved trying to get carbs up to 100g/day (I had a bad reverse T3 problem from low-carbing so not interested in repeating the experience).

The big exciting additions in stage 2 was eggs and ghee. I get to look forward to avocado and fermented vegetables in stage 3. No fried or grilled meats until stage 4. Meat is VERY boring without the Malliard reaction!

I'm aiming at gut healing rather than weight loss, but it's a pretty boring diet. ***********************************Potassium will fix your bp. It's been known FOREVER that low carb causes potassium loss, even Atkins said so in the very first book.

Insulin also causes potassium loss. It's one of it's physiological functions, so applies to endogenous insulin also. IME, Lantus is much worse than Novolog, Humalog or Regular.

When you lose serum potassium, it is replaced rapidly by cellular potassium, because serum levels must stay within a certain range to keep your heart going. So it doesn't show in bloodwork unless you get rbc tested as if serum leveles aren't normal, you're in an ER. Anyways, electrolytes are tricky to test since they changes so fast.

Low potassium relative to sodium causes fluid retention and hence raises bp. I always say people should use Lite Salt on low-carb, but it's sometimes not enough (NoSalt would be even better, but it's not edible, IMO).

Even the RDA says more than 4 grams per day, and few folks eat enough vegetables to get that from food.

If really bad, like you've been low-carbing for a couple decades and take gobs of insulin (i.e. you are me), it can cause edema. I have to raise my K-dur dose with rising Lantus doses or my feet blow up to where I can't walk!

The first year or two after my MI, I tested bp all the time. Now, I just look at my feet as I can guess my bp from them. When they are normal-sized, my bp is 120/70 or so. ***********************************Interesting thoughts about metformin.***********************************My hubby is having similar issues. I'm trying to sit down with him at the same time at least for dinner, even if we're eating different things. Or if I just ate, I can still sit and chat.

It helps if you don't keep YOUR favorite foods around for him to eat. I told him no cheese ravioli on his diet! But he can have potatoes in the same pot roast I'm eating without and it doesn't bother me.

He likes a lot of disgusting foods, like boxed macaroni and cheese, ramen, hot dogs and fish sticks. So he is getting his full dose of stuff I don't ever cook cause I don't like it. ***********************************Dieting in public means everyone gets to criticize. Only thing I'd have said was too few calories. But you said it first, so...***********************************I also think "measuring" such a small loss as you're going for is tricky. I can gain/lose 10 lbs going from ketosis to high-carb pigout - my water/glycogen loss is just a stupid amount.

So personally, I round my weight to the nearest 5 lbs anyways, and thus only see gains/losses in 5 lb increments. ;)

You're quite right that we're all different and respond differently. But you're not answering my question. How do you know how much protein to eat without knowing your lean body mass? Us me as an example: I'm male; 56 yo (next week); 154.75 lbs (as of this morning).

"You can not know how much protein to eat without knowing your lean body mass"

can't our natural appetite lead us to eat the correct amount? my appetite gets out of control with foods that raise my blood sugar fast. so if i restrict these foods, maybe i can trust my innate appetite monitor for protein. we have glucose sensors, maybe we have protein/amino acid sensors too.

Very interesting post. Thanks. I've heard that about potassium, but I have been using Not Salt and the Salt Substitute. But because I'm taking an ACE inhibitor, I worry about too much potassium, as it is potassium sparing. I checked this with a pharmacist.

If I weren't taking the drug I might experiment with potassium a bit more and see what it does. The fact that my blood pressure is capable of being normal tells me that there's hope.

But everything I've done that normalizes my blood sugar, especially interventions that cause me to secrete insulin in normal amounts causes the high BP. My guess is because I have been insulin deficient all my life, my body is adapted to a relatively low insulin level and normal insulin provokes an extreme response.

I have been using the average from months of using my Tanita scale every day which gives me a good enough number.

More confusing is the question of how much protein is needed to generate glucose for the neurons. We can't know this because we don't know exactly how much glucose our individual brain is burning.

The brain still needs glucose when you are low carbing, and gets it from gluconeogenesis. If you don't add extra protein for that, you will be consuming LBM no matter what your calculators tell you unless, like mine, the factor in average glucose consumption.

But few of us are average, and who knows how much glucose my brain burns, especially when I am thinking hard about everyone's responses here.

I have no comments on the scientific rigor with which you are conducting your experiment. Having to check my BG is enough math and science to take a big chunk of the fun out of eating for me; if I had to weight, count, convert, calculate and data enter every bite of food, I'd lose my mind. But I'm glad people like you are willing to take on these projects so the rest of us don't have to!

I have seen the "eat boring food, you'll eat less and lose weight" theory before and it always baffles me. I am a foodie, I love food. I love to shop, prep, cook, eat--everything but clean the kitchen. When I indulge my sensory foodiness, I nourish something essential in my soul.

When I "eat boring", or just plain don't eat enough for whatever reason, that alone starts me craving food, thinking about food, dreaming of food at night, fantasizing about food during inappropriate intimate moments. Nothing sends me running to break a diet faster than "boring" food.

Kim, Your understanding is wrong. Your heart and muscles burn ketones, and some brain cells, but not your neurons. After you are fully adapted to a ketogenic state they still require about 40 grams of glucose for the neurons. That need for glucose is why you have sugar in your blood at all times even when you are in a ketogenic state.

You don't have to eat carbs to provide it if you eat enough protein to supply that glucose via gluconeogenesis. If you don't, your body will catabolize muscle and use it to provide the glucose.

This is well known and documented in my book. It's also discussed in Lyle McDonald's book The Ketogenic Diet.

You got banned from ALC too? LOLz. Yea they banned me for arguing pro-calories being important many years ago. I also noticed they are super obsessed with food/desserts and so on. I tend to assume it's because tehy are eating such boring bland diets that it leads to food obsession.

A low flavor diet leads to being obsessed with food. I never have desires to eat cake because I eat tons of extremely tasty food all the time while being on a very low carb diet. Chocolate and cream and walnuts and granular erythritol is a lot tastier than junkfood. On the other hand, ALCs are eating like celery and boiled eggs and mayo so they are like OMG CAKE AND COOKIES HELP!! I went through that too after a super strict ketogenic diet eating nothing but meat and eggs and mayonaise and cream cheese and stuff. Atkins bars tasted like candy and a piece of diet bread with diet jam was like the tastiest thing in the world. Didn't make me binge but the point is, after eating such bland crappy food even trivially tasty things were ridiculously enticing.

Too many people are extrapolating very temporary changes in eating / appetite into long term prospects.

The long term effects of eating low calorie and low flavor is binging.

I got banned from Low Carb Friends. I'm pretty sure a certain number of their active posters are shills since they are always singing the praises of various products they sell.

The reason seems to be that I was telling people a) about calories and b) that they should stay away from the Frankenfoods and fad items. The moderator's official pretext for banning me was because I had mentioned the title of my first novel in the chat section which she claimed was "advertising" and against the TOS.

I've since heard from several other people active at the same time who were also blocked. Oddly, none of them had mentioned the names of their first novels, but all had warned about the Frankenfoods.

It was a blessing. I had been putting in a LOT of time answering posts there. When they banned me I realized how much time that waa using up, I decided never again to get sucked into a BBS and use the time for something more productive and lasting.

Re the boring food, I think this is, like so much, something that varies from person to person.

I couldn't do it for more than a week or two, but my dad (who shared my diabetic gene) ate the same identical meal for breakfast and lunch every day of his life as long as I knew him(no exaggeration) and his dinners were very dull too.

He told me he ate that way because he'd gained a lot of weight in his late '30s. He never gained another pound until he died at 100. He walked 3 miles every day and was in the best shape as he aged of anyone I've ever known. All his siblings died much younger of heart attacks. So some people do well on that WOE.

Not me! I love food and intend to keep loving what I eat. But this was a good change for me I had become a bit more obsessed with eating the past month than I wanted to be, largely because I went on a wonderful vacation where the food was amazingly good and ate much more than usual. Afterwards I couldn't stop eating at vacation levels.

Stephen Ferguson said: "Volek and Phinney recommend less than 0.8g per lb of lean body weight, which is about 17% by energy.

If you eat 35% protein, you'll simply be creating glucose through gluconeogenesis."

Having just heard an interview with Phinney, he said flat out that the PERCENTAGE of protein in your diet is a meaningless number, as the percentage can vary wildly depending on the carbs/fat/calories in your diet. So he uses an absolute number of grams of protein. He has a chart for protein intake, with a fairly wide range, based on gender and height. For me, a woman of 5'7", the range was something like 70-159g of protein daily. I tend to stay at the lower end as the higher I go in protein the higher my blood sugar goes. Jenny's 81g of protein looks right in line with Phinney and Volek's recommendations. The percentage looks high because her calories are so low.

"I had long periods when I wasn't hungry, but noticed that I did get hungry--often very hungry--in the evening 4 or 5 hours after my last meal. (No snacks on this diet!) I resorted to the "Two Gram Cure" and it worked. When I tested my blood sugar at these hungry time it was usually in the 70s."

I'm a bit baffled by my own blood glucose readings. Sometimes I feel like dirt--classic hypoglycemia symptoms with hunger and cravings and my BG is in the low 70's. Other times I feel just fine, but my BG is in the low 70's. I'm SO confused!!!

I'm on the verge of getting banned from LCF myself because I dare to suggest to people that they should just eat real food instead of manufactured crap--even stuff Netrition doesn't sell gets me in trouble. It just drives me bonkers when people want validation that it's OK to put flavored artificial creamer in their coffee because "cream has so much fat" and I can't keep my mouth (keyboard?) shut. Ugh!

jenny said: "I couldn't do it for more than a week or two, but my dad (who shared my diabetic gene) ate the same identical meal for breakfast and lunch every day of his life as long as I knew him(no exaggeration) and his dinners were very dull too. "

what did he eat for breakfast, lunch, and dinner? did he also display a liking for 'sameness' in other areas of his life?? i.e. same style of clothes all the time, same ...come to think of it, most elderly people i know like to keep everything the same!!

Dinner: More variety here but usually: Small serving of meat without fat or salt, small salad, small serving of veggies, often frozen. Potato (usually). I slice of bread. Dessert: fruit

He had a very scheduled life but many activities, lots of travel, and he worked his profession until he was 92 which was most of what he put his time into when not at concerts, at the beach, or abroad.

There is NO supplement that has any of the effects metformin does. The only plant that contains a similar chemical is poisonous. Even an earlier pharmaceutical with a related chemical structures killed people. Because these chemicals work on the liver they have to be just right.

Plus, why would you want a supplement. They aren't regulated, you don't know what toxins are in them (many lab tests show everything from heavy metals to 1st generation sulfonylureas in "diabetes" supplements. Those 1st generation sulfs cause heart attacks and dangerous hypos.) And most supplements are MORE expensive than metformin, which has a 50+ year history of use in the marketplace.

jenny, today i forgot to take my bagged lunch and i only had a few dollars with me, so i had to buy just coffee with whipped cream and a slim jim for lunch. for breakfast i had only had 3 boiled eggs with lo-salt. later on this afternoon i had a weird hormone taste in my mouth. i had that same taste during a short period of time when i was wearing the blue light blocker glasses at night around 7 30pm on in the winter. what hormone was that?? may it have something to do with burning ketones? i usually never eat so little for lunch.ps what was your dad's job?

Jenny, I have your book but am new to your blog. I am very confused still about blood sugar. When doing a ketogenic diet blood sugars range between 88 and 118 1-2 hours post eating. AM fasting levels are always high 115-125. If not doing LC they can be up to 135 fasting and typically 118 - 125 1-2 hour post meal. I have tried Metformin a couple of times. I got weird symptoms such as insomnia and heart fluttering. Was nervous that my symptoms sound similar to diabetic drugs that have been taken off the market. When doing some research online, I founds that others have had this reaction. I am also one of those who responded poorly to a LC diet with insomnia, hairloss etc. Can you speak to the Metformin issue? I am at my wits end! thanks for any advice you can offer!

The symptoms you describe with metformin are not the symptoms of lactic acidosis which is the condition that got phenformin removed from the market.

How long did you take the drug? Some people need a few weeks to adapt to it.

Otherwise, you have the pattern where fasting readings are diabetic but others aren't, which is true of a small group of people with diabetes, many of them male.

Unless your doctor tells you not to (based on lab reports of abnormal kidney or liver function) I'd suggest trying the met for a month to see if you adapt (and if it helps with your fasting blood sugar.)

If it doesn't, you might discuss with your doctor using a small amount of levemir, a long acting insulin, to control your fasting sugars. Long acting insulins are made specifically to lower fasting blood sugars.

"There is NO evidence in the scientific literature, physiology texts or any similar source that I've come across to support the exhausted pancreas theories espoused in low carb circles. It matters not how many repeat this meme, it doesn't make it so, and the onus is on those making the claims to back them up. Eating sugar or carbohydrates in general does not cause diabetes. The pancreas has more than enough insulin making capacity to last more than a lifetime. It's not like eggs in your ovaries as I've seen the analogy drawn. Yes, with aging comes some declining function, just as sarcopenia can become an issue, but that decline is not due to having used up some insulin reservoir. Eating a low carb diet to avoid getting diabetes on this basis is, frankly, downright foolish."

I agree that beta cells don't "burn out" but that isn't the reason why cutting carbs can prevent diabetes. What damages beta cells is long term exposure to blood sugars over 150 mg/dl. This is called "glucose toxicity" and has been demonstrated conclusively by research. If your diet is allowing blood sugars to spike up to 190 after each meal, even if they drop below 140 at 2 hours (and are officially "normal") they are causing damage not only to the beta cell but to the linings of your blood vessals. (Again, solidly proven.)

I'm curious about your comment to Kb. I'm not (I don't think) diabetic, but when I'm eating low carb, my fasting glucose levels are often high - up to 125 at the highest (which is very early in the morning before 5am), while my pps are in the 77-96 range. Should I be concerned?

Also, Part of the reason I choose toat low carb is to avoid diabetes. Which my grandmother has but she is the only relative in my family with it. I agree with what you say: if a low carb meal helps to avoid dangerous and harmful blood sugar spikes, which is well known why would someone call it foolish?

There's a meme going around the Paleo world that low carbing "causes" elevated FBG's, but I haven't seen any peer reviewed studies to that effect (haven't looked, however). The few low carbers who acknowledge that seem to think it's not a problem.

I take Metformin in part because of elevated FBG's. I never tested before low carbing, so I can't say whether low carbing caused it or not, I suspect it was much higher when I was eating too many carbs. Post prandial BG's are usually in the 80's and 90's on low carb, whether I'm taking Met or not.

I wish there was more research on fasting blood glucose in low carbers. My last A.1c was 4.1....but I'm quite anemic so the results are skewed, I know (how skewed, I wish I knew).

I can't really see myself taking Metformin even though the fasting levels are somewhat high because I feel pretty great....I don't have any of the 'symptoms' of out of control glucose (except obesity...yeah, there's that one:)

But I am curious and a bit concerned...Chris Kesser has acknowledged it a bit on his blog, but since the ideas we have about FBG come from studies of people eating the standard American diet, as far as I know, there is no real way to tell.

TL, The fructosamine test is the appropriate test for someone who is anemic. There's no point in administering an A1c in that situation. The fructosamine test will give you a good idea of your blood sugar control over the previous six weeks.

Obesity is not a sign of an out of control blood sugar. When they go truly out of control, people start to lose weight. Obesity is a sign of an appetite that has become dysregulated, and that is often because of steeply rising and falling blood sugars, though the hunger doesn't tell you how high they are going. Some people get very hungry with surges in the high normal range.

But the research suggests that damage is caused by spending hours over 140 mg/dl. If you aren't, you shouldn't stress.

Unfortunately, even though we know the reason for it, we still have to do something about it. I've had to cut way down on my carbs since late December because, for me, even if my blood sugar is fine, if it is fine because my body is cranking out insulin, my blood pressure will rise. Cutting way back on carbs lowers my blood pressure very nicely right now, though I have to say after 3 solid weeks of being in ketosis at all times my weight hasn't budged a pound. Not surprising because I have given up on eating at the calorie level that will give me weight loss since it is a starvation diet.

Does anyone else have a suggestion on making it as easy as possible?I've been able to do this in my head when not using insulin. I cannot use the computer at work for personal use, and I dread carrying around print outs and tables and a calculator to figure out insulin, carbs, and digestive rate. Plus, you need to know in advance (15'' to 1 hour in advance) the carb nature of what you will eat. Some think that the modified insulin pens make this easier (perhaps they are now better than Dr. Bernstein's experience in his "Diabetes Solution.)"

Is anyone using a current production portable device and a program to figure all this out and track it? All of the ones I have looked at are disappointing. Perhaps some software associated with the meter??

Dr. Bernstein only uses humalog for fast acting insulin. I found that the absolutely worst insulin to match to food. With Novolog or Apidra, newer insulins, I could inject right before eating and it would match the activity of the carbs.

Also, once I figured out my insulin carb ratio, it did not require intense precision to use the insulin. I am very insulin sensitive, so I would inject 1 unit per 10 grams and that would do it. If I wasn't sure what I was going to eat I would inject part of the insulin and then test at 1 hour and inject more if it was needed.

Someone gave me a Novopen intended for kids that had half unit markings, but I ended up not needing them.

I did best using insulin with about 100 g a day, unlike the advice that Dr. Bernstein gives. Before that I had been eating about 60 g a day, tops, and seeing numbers higher than I wanted to see.

I have huge respect for Dr. Bernstein, but find it incomprehensible that he admits to never having tested the newer fast acting insulins. I used some samples of Apidra and it found it t work exactly as fast as carbs,

People are different, and some people might do better with Humalog, but all it did for me was lead to spikes and lows. My guess is that is why Dr. Bernstein doesn't believe it is possible to cover a higher carb intake with fast acting insulin.

Pumps use Apidra nowadays and work very well for many people who use them, too. Dr. B is very hostile to them, but I think his experience may be based on much older pumps with older insulins.

Jeffry,I use the CRON-O-Meter (http://cronometer.com/) to track my food intake and think it is wonderful. It was designed for those who follow formal Calorie Restriction with Optimal Nutrition. It is free and has an app edition. Also an upgraded "Gold" edition, which I haven't tried.

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Visit the mainBlood Sugar 101 Web Site to learn more about how blood sugar works, what blood sugar levels cause organ damage, what blood sugar levels are safe and how to achieve those safe blood sugar levels.

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I was diagnosed with diabetes in 1998. Since then I've kept my A1cs in the 5.0-6.0% range using the techniques you'll find explained at The main Blood Sugar 101 Web Site, where you'll also find extensive discussion of the peer-reviewed research that backs up the statements you read here.

I've also published two books on related subjects, Blood Sugar 101: What They Don't Tell You About Diabetes, which was an Amazon Diabetes bestseller for 3 years and Diet 101: The Truth About Low Carb Diets.